Greater quantities needed to hit vaccination target

The state’s immunization plan prescribes vaccinating medical and nursing home staff and risk groups first – some 315,000 people. Photo: Ain Liiva / Virumaa Teataja

Estonia’s COVID-19 immunization target of making vaccination freely available by June is unrealistic considering current vaccine quantities.

The state’s immunization plan prescribes vaccinating medical and nursing home staff and risk groups first – some 315,000 people. That number would grow to 350,000 with the addition of non-medical front-line workers, such as rescue or police officers.

The immunization plan suggests that the vaccine should be available to everyone in the second quarter or by the second half of June at the latest. This would require 13,500 front-line workers to be vaccinated every week, which would in turn require 27,000 doses of vaccine as surefire immunity requires two shots. That is the rate of delivery and vaccination needed for non-essential vaccinations to begin in the second quarter.

Unanswered questions

Member of the government’s COVID-19 advisory council and professor of applied virology at the University of Tartu Andres Merits has said that a return to normality would require three-quarters of the population to be vaccinated. This comes to 996,000 people or virtually every adult resident as there are no vaccines for children and pregnant women yet. Vaccination of children will begin once a suitable vaccine becomes available.

Lifting all restrictions by the end of next year without it resulting in adverse effects would require vaccinating 19,000 people every week using 38,000 doses of vaccine.

Estonia has joined several pre-purchase contracts to procure enough vaccine for 2.1 million people to manage risks. Pfizer/BioNTech is the only manufacturer already supplying Estonia with its vaccine and can deliver 10,000 weekly doses. “Deliveries based on the contract with Pfizer/BioNTech will allow us to vaccinate 5,000 people every week,” Minister of Social Affairs Tanel Kiik (Center) said in a press release sent on Monday morning.

This means that vaccine deliveries would have to grow before the target can be met.

COVID-19 vaccines that arrive in Estonia are kept at the Health Board’s central warehouse that will be supplying family medicine centers in charge of vaccinating the general population. Postimees asked the board how many doses of vaccine the warehouse expects to take delivery of and when. Eike Kingisepp, media adviser for the Health Board, said there is no such information at present.

The social minister expressed hope that vaccines of other manufacturers would soon be issued sales permits, which is when Estonia can hope to secure more doses.

Postimees asked Tanel Kiik and the ministry’s communication department additional questions, including by how much could quantities grow, what is Estonia’s current vaccination capacity and whether vaccine deliveries could pick up enough speed for the immunization target to become realistic but received no answer. Minister Kiik said it was impossible for him to address the questions because of back-to-back meetings, which is why he asked the communication service to answer them.

The European Medicines Agency will evaluate the Moderna vaccine next on January 6. A positive decision would see the European Commission issue the vaccine a sales permit.

Chairman of the Estonian Family Medicine Association Le Vallikivi said that family physicians are ready to start vaccinations and that immunization of risk groups will begin as soon as medical staff and nursing home employees have been inoculated. “We will get to risk groups toward the end of January, beginning of February if all goes well,” Vallikivi said, adding that family doctors have a clear vaccination plan in place.

The Health Insurance Fund will forward lists of people belonging to risk groups to family medicine centers in early January. The plan is to start with the most vulnerable groups. “We do not need the entire risk group showing up and spreading the virus in the waiting room. Immunization needs to be systematic,” Vallikivi said.

Head of infection control for the North Estonia Medical Center (PERH) Mait Altmets said if it proves possible to vaccinate medical staff in the first quarter of next year, hospitals should be able to lend a hand at vaccinating risk groups after that.

“We have made preparations for vaccinating the population or at least people belonging to risk groups once we have vaccinated our staff. In a situation where we maintain vaccination rooms and handle immunization on a daily basis, why not also administer COVID-19 vaccines,” Altmets said. He said that the hospital could vaccinate patients who belong to risk groups.

Backup plan in place

Le Vallikivi said that the pace of vaccination will ultimately depend on vaccine supply and size of risk groups. “Every center will decide how to go about the process based on patient profiles and vaccine deliveries. Whether there will be specific days for vaccination or whether time will be allocated in the mornings or evenings,” Vallikivi said, adding that a single doctor or nurse can vaccinate four or five people an hour.

The head of the Estonian Family Medicine Association said that people who refuse to be vaccinated will surrender their place in line to those who would not otherwise be considered first priority.

“You also cannot tell a 90-year-old who has trouble getting around to be there in 18 minutes lest the dose of vaccine expires. You simply take the next person in line,” Vallikivi explained.